Provider Demographics
NPI:1588181259
Name:BURKE, KATELYN ELIZABETH (NP)
Entity Type:Individual
Prefix:MISS
First Name:KATELYN
Middle Name:ELIZABETH
Last Name:BURKE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 LINWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-3808
Mailing Address - Country:US
Mailing Address - Phone:603-339-8294
Mailing Address - Fax:
Practice Address - Street 1:33 BARTLETT ST STE 504
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1319
Practice Address - Country:US
Practice Address - Phone:978-458-6212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-24
Last Update Date:2017-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2272612207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine